STORY ARCHIVE

“Don’t Die Young” Episode 3 – “Heart”

As a hard-working organ, making sure that every muscle, tissue and cell in the body gets just what it needs, the heart is in need of some love.

Thirty-six-year-old Stephen Hall is putting his heart under plenty of stress. As a self-confessed workaholic running his own busy gastro pub, he is finding life pretty hectic. When he wants to wind down, he does all the wrong things – binge drinks, binge smokes and binge eats. He’s putting strain on his heart, and even when he tries his best to exercise by playing football, he becomes so stressed out on the pitch that he often gets sent off. Alice puts Stephen’s heart and stress levels through a series of tests and, when he gets the results, he knows he has to make some drastic changes to his lifestyle.

Alice also puts her own heart under plenty of pressure – 3,000 feet up in a stunt plane, performing acrobatic stunts to find out just what happens to her heart rate when it’s under stress.

When she’s back on the ground she visits a pub and a chip shop – all in the name of good science, of course – to analyse just what happens to her heart when she’s drinking alcohol and eating chips with a slathering of grated cheese on top. Alice also finds out why a couple of alcoholic drinks are good for the heart, and sees for herself just how greasy chip fat looks when it hits her blood stream. Armed with this new knowledge, people can all make choices to keep their hearts – and all the organs in the body – working better, for longer.

TRANSCRIPT

Dr Alice Roberts: Our bodies are extraordinary. We throw all sorts at them, and they hardly ever let us down. Today I'll be putting my heart to the test, in a chip shop and down the pub. And meeting one man who's giving his a hard time.The heart is an incredible organ. It pumps blood containing oxygen and nutrients all around the body, making sure that every organ, every tissue, every cell, gets exactly what it needs.I'm wearing a heart rate monitor, just there. It's connected up to electrodes on my wrists, which are going to be recording my heart rate - all the time that I'm in the air.

Pilot: Three, two, one. Up we go!

Dr Alice Roberts: Oh my God! (Screams and laughs)We're flying at 220 miles per hour, and have just reached 3,000 feet in 45 seconds. My heart is starting to pump really fast now. I think that's brilliant, Mark. Oh my God! Oh my God!We're accelerating at 3 Gs, that's the acceleration three times gravity. My heart was having to pump hard, to get the blood out of my head. It feels very weird.

Pilot: Here we go, nice and high.

Dr Alice Roberts: Mark, my eyes started to go weird then.

Pilot: OK. Well, that's your body telling you that it's starting to struggle a little bit, under the G.

Dr Alice Roberts: Wow! As we come down, so does my heart rate.Well, the heart can rise to meet the challenges that we throw at it but it does need looking after as well, and that's down to us.

Thank you.So, Travis, you can see how big the heart is compared to the chest, in this MRI - that's the heart there. And your heart is about the size of your two fists put together. That's about the size of your heart.

Travis: That's reasonably big.

Dr Alice Roberts: Yeah, and it's bigger than mine. Which makes sense, because you are bigger than me. So I am going to start painting. A very useful landmark in a bloke, which is the nipple, the left nipple, and I know that the heart, the point of it, goes right down to the left nipple. It's obviously not as reliable in a woman.

Travis: So why is that then, Alice? (Laughs)

Dr Alice Roberts: Well, because the nipples aren't in exactly the same place in a woman.It's quite strange, because the heart has got four chambers - it's got a left and a right atrium, which means 'hallway'. There's a right atrium, just there. And the right ventricle, just here. And there's a left atrium and a left ventricle as well, but they're sort of tucked around the back.And this is a heart frozen in time, because, of course, Trav's heart inside his chest is pumping away. Every heartbeat.

The health of your heart is massively influenced by your diet and lifestyle.36-year-old Stephen Hall runs his own gastro pub. He moved from London to Cheltenham to escape the rat race, but it followed him there. He runs the pub with his wife Becky. Stephen's the chef. The stress in Stephen's life is obvious - to him, and everyone around him.

Stephen Hall: Three pork - how do they work that one out?

Kitchen worker: Three pork?

Stephen Hall: Yeah. How can that be there?I drink a lot more than I used to. I binge smoke, like I won't have a cigarette all week and I'll have about 40 on Saturday night.

Becky Hall: And a bottle of red wine to yourself.

Stephen Hall: Yeah, and yeah - drink copious amounts of alcohol. And then like, I eat, like, chocolate - like, bags of chocolate.And eat it till I feel quite sick. Bizarrely. I've now stopped to kid myself. Whereas before I was like, you know - still young, still young, still young. But I'm not, I'm staring 40 down a barrel and... You know. I need to do something or some things to help it. You know. Because I don't wanna die young.

Dr Alice Roberts: Stephen's right to be worried. We've seen what a heart's looked like from the outside. But there's much more to see inside.This is a heart. It's actually a pig's heart, but it's about the same size as a human heart, and it's one big muscle contracting to pump the blood around your body. Contracting 70 times a minute for every minute of your life.The contractions are sparked off by the heart's own pacemaker.It's a little bunch of cells that creates a wave of electricity which spreads across the heart, making all the muscle cells twitch together.But it's not the muscle contraction that makes the all-too-familiar sound.If I listen to my heart, I'm going to hear something a bit different. I can hear two sounds going, "Lub-dub, lub-dub, lub-dub."And it's not the contraction of the heart or the wave of pressure that I'm hearing now. It's actually the closing of the valves inside.

I'm using ultrasound to see my heart valves. And Kelly's here to help me.So we've got the four chambers of my heart here. Upside-down. These are the two atria, and here are the two ventricles. That's the left atrium just there. And that's the mitral valve, opening into the left ventricle. And you can see it opening. So as the atrium is contracting, it's pumping the blood through. Can you see it opening and shutting on every heart beat?This is wonderful, because you know, I'm an anatomist, I know what the heart looks like, but to see my own heart actually working and the valves opening and shutting is just fantastic.But what do those valves look like in the flesh?

And you can just see the edge of that valve. And there are little strings attached to it, holding the edges of the valves down. So these are... ..the heart strings. The heart really does have heart strings.

Stephen's swapped his chef's apron for a lab coat. I've invited him to my lab so he can understand why his heart is worth looking after.

This is the left ventricle just here. So if I cut into that gently... ..carefully... I'm not through it yet. I can't feel the hole in the middle. You can see how deep the blade's going in. I'm just in. Should be able to open that up.Just look at that. That's the thickness of that ventricle wall.

Stephen Hall: Good enough to eat!

Dr Alice Roberts: Well, it is in this pig heart. It's just the same in a human heart - you've got this incredibly thick muscle wall on the left-hand side, pumping the blood out around the body, and this thinner-walled ventricle on the right-hand side, pumping blood out to the lungs. Can you see that sort of membrane?

Stephen Hall:Yeah.

Dr Alice Roberts: That's all part of the valve, just there.

Stephen Hall:So if that wasn't working, you'd be pretty much done.

Dr Alice Roberts: Yes, absolutely. And in fact, that's one of the things that happens. If you have a heart attack and it damages sort of the muscle here, then the blood is going to be able to rush backwards through that valve every time the heart pumps.

Stephen Hall:Right.

Dr Alice Roberts: I would like Stephen to seriously think about changes he can make to his lifestyle to protect his heart. Heart attacks are caused when the heart's own arteries get blocked, and major factors causing this are smoking, poor diet, obesity and stress.Smoking is one of the most damaging things you can do to your heart. It makes your arteries fur up on the inside and your blood more likely to clot.Stephen's smoking a lot. And he's stressed as well.

Stephen Hall: Pub trade is like restaurant trade. You know, you're only as good as your last service.

Chef: What are they having?

Stephen Hall: And when I'm not fresh and when I'm stressed, the business suffers. And it's a vicious circle, 'cause when the business suffers, I get stressed and then I'm not fresh!

Dr Alice Roberts: When we're stressed, our adrenal glands produce adrenaline, and another hormone called cortisol. This increases blood sugar and blood pressure, which is OK in the short term but if your cortisol levels stay high, it's very bad news for the heart. So what about Stephen's cortisol levels? He certainly looks stressed on the outside. And after a heavy night, he's not on sparkling form.

Dr Alice Roberts: Over the course of a busy day, we're measuring Stephen's blood pressure and cortisol levels every two hours. Despite his hangover, Stephen's cooking 70 meals in three hours. And it isn't easy.

Stephen Hall:We've sold 36. Chickens...how many chickens out?

Chef: Eight.

Waiter: Eight.

Waitress: Eight chickens.

Stephen Hall: We haven't got any food!

Waitress: Steve, on table 33, can the chicken have a Yorkshire pudding, please?

Stephen Hall: No. If I had some, you could have it, Holly, believe me. But I don't have them!

Dr Alice Roberts: We'll come back to the results later.Stephen does try to tackle his stress levels, and keep his heart healthy.

Stephen Hall: I run around like an idiot for five minutes and probably hack me guts up and come off. If I'm not asked to leave before that! It can look quite embarrassing. Or so I've been told, yeah. It's like, "Give up, fatty" I hear sometimes!

Becky Hall: Oh! No!

Soccer player: Well done, Steve! Get rid of it! You alright?

Stephen Hall: I think I got off worse than you. It's come up like a balloon.

Dr Alice Roberts: But not all exercise has to be that painful. Some have opted for a slightly less conventional method.

This is the Bristol laughter workshop. De-stressing the body with coach Joe Hoare.

Joe Hoare: Cheese.

Workshop members: Cheese.

Joe Hoare: And focus on the 'ee' bit of it. So cheeeese.It's a very vigorous cardiovascular workout. So what happens when you laugh is first of all, your blood pressure goes up. And then after the whole sort of moment of mirth bit subsides, your blood pressure and your heart rate then sort of drop to a lower, sort of steadier level. That's the general sort of pattern.

Joe Hoare: Good. When you smile and laugh, you release endorphins and their our body's natural painkillers and stress relievers and so on and so on. It's a great sort of muscular relaxant, all this smiling and laughing. It helps us sort of feel on top of life.

Dr Alice Roberts: Things aren't so much fun back in Cheltenham. We measured the levels of the stress hormone cortisol and its effect on Stephen's heart during a busy lunchtime service. I'm meeting with stress expert Julie Turner-Cobb who has his cortisol results and the footage of the experiment.

Cortisol is normally high in the morning, helping us get up and go, and then slowly decreases throughout the day. But Stephen's cortisol is low first thing, rising to a peak mid-morning. Stephen's facing his stress for the first time.

Stephen Hall: Turn the vegetarian around.Oops.

Dr Alice Roberts: Bit of a Gordon Ramsay moment there, Stephen?

Stephen Hall: You just don't know you're doing it.

Dr Alice Roberts: You're pacing up and down.

Stephen Hall: Yeah, 'cause we open up at 12 o'clock on a Sunday and usually we do very few dinners between 12 and 1. You know you're gonna get sort of spanked at 1 o'clock 'cause you know, everyone and their aunt comes in at the same time.

Dr Julie Turner-Cobb: And that fits very well with your cortisol profile. Because the whole idea that with cortisol, as you were saying, that you're ready for dealing with stress. But if you're pacing up and down, you're actually producing this hormone such as cortisol but there's no... you're not using it up at all.You're not running anywhere or having to do anything in the kitchen.

Dr Alice Roberts: Stephen's abnormal cortisol levels are definitely having an effect on his heart.These are fairly high blood pressures at the moment.

Stephen Hall: Are they? 'Cause I don't know what's normal. What is normal?

Dr Alice Roberts: 139 / 94. This is what I find really weird, is that your blood pressure's gone right up to 150 systolic at 4 o'clock, which is when you're finishing. I mean, it's not desperately high, but I mean, I think if you've got these changed cortisol patterns and it's chronic, then stress certainly has a bad effect on your heart and your blood vessels.

Stephen Hall: Right. So how do I change this, then?

Dr Julie Turner-Cobb: There are no quick fixes, but there are things that work very effectively. Um, and I don't know what sort of things you're into, but um, for some people it's relaxation, tai chi, yoga, those sorts of things.

Stephen Hall: No, no, no, no!

Dr Alice Roberts: If, like Stephen, you're not into yoga or meditation, then any moderate exercise will be good - even just walking the dog. But trying to deal with stress can often lead us to make the wrong choices for the health of our hearts.

Stephen Hall: My way of dealing with it sometimes is once a month I go out to London and have a bender with a mate for three days.

Dr Alice Roberts: Excessive drinking raises your blood pressure and makes your blood more likely to clot. But we're forever being told that moderate drinking can be good for the heart.So I want to find out how and what is moderate, anyway?

I've come to Edinburgh to meet cardiologist Dr David Newby, to measure the effects of alcohol on my arteries. And where better to find him than in his local pub.

There's a glass of red wine sitting here lurking.

Dr David Newby: Yes, it looks alright! Ominous, isn't it?

Dr Alice Roberts: It is. Very ominous.

Dr David Newby: Your job, should you choose to accept it, is to drink the glass of wine and we'll see whether these arteries can relax a little bit more with the effects of alcohol.

Dr Alice Roberts: David's got a pulse wave monitor which will analyse the pressure of blood flowing through my arteries. So do you need to measure them to begin with?

Dr David Newby: Yes. So what we need to do is put this little pressure transducer on there, the radial pulse. And make a recording on the screen.

Dr Alice Roberts: So it's not just measuring the rate of my heart, then?

Dr David Newby: No. It's not just the rate. It also shows the overall wave profile.

Dr Alice Roberts: So this is the blood surging through the artery every time my heart beats?

Dr David Newby: That's right. And so when the blood's going through the body, the arteries have a tone themselves. And when you drink alcohol, the arteries relax a little bit so that the way that the wave passes down the body changes.

Dr Alice Roberts: So it's a little bit like sort of the whole body effects of alcohol, that, you know, you feel generally relaxed but actually inside you, all your blood vessels are relaxing as well.

Dr David Newby: Absolutely, and we know that if your arteries are stiff and tense, then that's a bad thing and you can cause heart attacks and strokes and things like that.

Dr Alice Roberts: Right. So!

Dr David Newby: Get the wine down, and let's see what happens.

Dr Alice Roberts: If my arteries are relaxed, then my heart won't have to pump so hard pushing the blood through my vessels. 30 minutes and two glasses of wine later...So David, this is the trace in my heart now that I've had a couple of glasses of wine?

Dr David Newby: That's right. This is the pressure trace now.

Dr Alice Roberts: Right.

Dr David Newby: If I was to show you what you were like before we did this...

Dr Alice Roberts: Yep. Ooh! That was...yeah, much higher.

Dr David Newby: See that?

Dr Alice Roberts: Yeah, yeah.

Dr David Newby: It's not until you have the alcohol that we move to this nice relaxed state where your arteries really are very comfortable and compliant and relaxed. Really reduces the amount of work that your heart's doing. So, um...

Dr Alice Roberts: Presumably this effect doesn't just carry on and on, though. I mean if I was to drink more and more glasses of wine, I think the good effects of the alcohol would wear off and the evil effects would start to...

Dr David Newby: Absolutely. Two or three drinks two or three times a week is very good for the heart. Keeps the blood flowing, keeps the arteries relaxed, and stops the furring up and the hardening of the arteries that we see when we have, er, heart attacks and strokes.

Dr Alice Roberts: Cheers.

Dr David Newby: Cheers!

Dr Alice Roberts: So drinking moderately is good for your heart by relaxing the arteries and easing blood flow. I think Stephen's now convinced that he needs to make changes to his lifestyle.But he's going to get his cholesterol level checked and also have a coronary risk assessment, which will predict his chance of developing heart disease over the next 10 years.

Stephen Hall: Hello.

Nurse: Hi. Yep, if you'd like to come on through.So what we're going to do is we're going to measure your cholesterol but we're also going to measure your blood glucose.

Stephen Hall: OK.

Nurse: That's your blood sugar. And do you know your weight?

Stephen Hall: Er...49.

Nurse: OK. Here we go. That just requires a very small...

Dr Alice Roberts: Whenever we hear about cholesterol, it seems to be as something that's just bad for us. But in fact it does an essential job in our bodies - it's part of all our cells.

Stephen Hall: What relevance is the - actually, your waist size has to do with...?

Nurse: If you carry a lot of your weight around your waist - central obesity - you're more at risk of cardiovascular problems or diabetes.

Stephen Hall: Oh, I see. Right.

Nurse: Compared to if you carry it sort of lower down on your hips.

Stephen Hall: Gotcha.

Dr Alice Roberts: But too much cholesterol in our bloodstream can be bad if it gets taken up into the walls of the blood vessels. So here's a nice wide open artery that the blood can flow straight through. And what happens is that fatty deposits get laid down inside its lining. So the blood is having to flow through a narrower and narrower hole. And then if you're really unlucky, a clot can block it completely. One way to reduce blood cholesterol is by eating the right fats. But it is a bit confusing - there's saturated, unsaturated fats, and omega-3. Some are good, some aren't so good. I'm going to meet nutritionist Sue Baic to help unravel this mess.

Simply put, saturated fats are animal fats, and they tend to be solid - lard, cheese and butter.

Sue Baic: So that's the type of fat we said will put our cholesterol levels up, will block our arteries. So in terms of heart health, that's the sort of fat that we're looking at reducing.

Dr Alice Roberts: The good fats are unsaturated. And these are liquid, so they're oils - vegetable and olive oils. What about these spreads that have got olive oil in?

Sue Baic: Ah, well let's have a look at these. We've got only 13% saturated fat.

Dr Alice Roberts: Right.

Sue Baic: So it's a much better type of product, really.

Dr Alice Roberts: So that really is better for you than butter?

Sue Baic: Well butter, as I said, has got a very high saturated fat content, so that's what it means - it'll put your cholesterol levels up. If you choose a fat that's got more unsaturated fat, it won't have that effect on your cholesterol levels.

Dr Alice Roberts: There's one oil that's more heart-friendly than any other - omega-3.

Sue Baic: Omega-3 is really beneficial for the heart It affects the blood pressure, it affects blood clotting. It's a really useful fat to have. And there's not many sources, apart from oily fish, really.

Dr Alice Roberts: So the key to it all is getting the right balance of fats and oils in your diet.

Sue Baic: What we're doing is, we're not saying you shouldn't have any saturated fat in your diet. We're just saying that most of us have got the balance wrong and we're having too much of the hard animal fats and not enough of the good vegetable fats, really.

Dr Alice Roberts: Well, there we go. I'd better pay for this lot! So vegetable and fish oils are good for us, and we should cut down on saturated fat.But it's all very well seeing these things in their packets. What happens when you eat them?Hello.

Fast Food Shop Asst: Hello.

Dr Alice Roberts: Please can I have - let's see what you've got. Er, may I have a medium-sized portion of chips with cheese.These chips are gonna be tasty, but they've also got the worst type of fat in them.Ooh, they look really good!Great! Thank you very much.And that's trans fats - the type that really stuffs up your arteries.You can't have any. They're all mine.Now, most of the cholesterol in your blood doesn't actually come from your diet. It's made by your body in places like the liver.Nice chips.

And too much saturated fat alters the way that cholesterol is carried in your bloodstream and makes it more likely to be taken up into the walls of the arteries.

And of course usually, once you've eaten a meal like that, it's out of sight, out of mind. But not these chips. I'm going to see them again - or at least, I'm going to see the fat again. I'm off to have my blood taken.

It's a good hour and a half since I ate my chips - time enough for them to have been absorbed into my system. So to see these fats in my blood, we need to spin it in this centrifuge machine. By spinning it, the lighter parts - including the fats - will float to the top.

This is the moment of truth.Open up the centrifuge machine. I've just about finished bleeding now, I think.And that does - I mean, it honestly does actually look like chip fat that's been used a few times!

In fact, that fluid on the top is blood plasma, but it should be clear, and it's the fat in my blood that's making it cloudy.And that fat is used by the body. But if you ate lots and lots of chips, and lots of things with saturated fat and trans fats in, it would increase the amount of bad cholesterol that there is in your bloodstream at any one time.So I think I'm going to carry on eating chips but just not too often.

Stephen's coronary risk assessment and cholesterol test is finished.

Nurse: Your total cholesterol ratio is quite high.

Stephen Hall: So 6.2. What's the normal?

Nurse: Um, the average in the UK is between sort of 5 and 6.

Stephen Hall: So that's advising me to see my GP. It is, yeah.

Nurse: 'Cause your coronary risk score there is coming up as 39%. So that's your risk in the next 10 years.

Stephen Hall: That's quite high. Oh right, I see.

Dr Alice Roberts: If the results show the risk of cardiovascular disease is more than 20%, you're advised to see your GP. And Stephen's is a whacking 39%.

Nurse: And obviously there are changes to your lifestyle that you can make. So yeah, your smoking - obviously if you quit smoking, that'll help improve your score. If you reduce the amount of alcohol and obviously if you can increase your physical activity, that would also improve your levels. OK?

Stephen Hall: Sure. My risk - what, it's 39?

Nurse: 39. Yes, that's correct.

Stephen Hall: So I'm aiming for 20.

Nurse: You're aiming for 20.

Stephen Hall: Right, cool. OK.

Nurse: OK?

Stephen Hall: That's good. I don't know whether to say thank you or not! But cheers.

Nurse: Alright.

Dr Alice Roberts: It's a wake-up call for Stephen, and he needs a plan. His wife Becky is keen to help.

Becky Hall: So basically, you're in deep trouble within the next 10 years then?

Stephen Hall: Well, not deep trouble. But it tells you what basically percentage you're likely to have heart disease within the next 10 years if you continue to be what you are now.

Becky Hall: Right.

Stephen Hall: Which is 40%, which is quite high, so...

Becky Hall: So what, what is that from? Is that from diet? Is it from lack of exercise?

Stephen Hall: Everything. Everything.

Becky Hall: Stress?

Stephen Hall: Smoking, drinking, diet, stress. Everything. Lifestyle.

Becky Hall: So we're gonna sell up and sell coconuts on the beach, then?

Stephen Hall: That's right, yeah. No, it just means, like, going back to the gym again one day a week, and make sure I have a more... I don't know, a stricter regime when it comes to fatty foods and the usual stuff. And finally give up smoking.

Becky Hall: So how can we...my big question is, how can we implement that kind of consistency, really?

Stephen Hall: I don't know. Just show me my test results all the time.

Becky Hall: Alright. So we need to print them off and stick them in front of you.

Stephen Hall: Frame 'em!

Becky Hall: OK. We'll do that, then.

Stephen Hall: Yeah.

Dr Alice Roberts: Small changes to your lifestyle can make a big difference to the health of your heart, so I hope that Stephen will manage his stress from now on and that he'll create a bit more time for himself.

So when it comes to the health of our hearts, we need to cut down on saturated and trans fats - so no more cheesy chips for me - but the odd glass of wine is fine and actually good for the heart. And we need to minimise our stress levels, so keep smiling.

Next time, I'll be taking a closer look at the workings of our eyes. I'll meet a woman with a family history of eye problems and find out if the way she lives and works affects her eyes.

Woman: Is it genetic, is it something that you get in your family?

Dr Alice Roberts: I'll see what life is like when your vision lets you down.

I've got no idea what the number is or the destination on it.

Dr Alice Roberts: And I'll find out how we can best protect our eyes from damage.

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diane - 30 Sep 2009 3:05:33pm

i found this very interesting,i have been suffering from depression and low self esteem for 40 years,i have also suffered from chest pain and fingers turning blue and freezing feet,for 20years,i have been suffering anxiety and panic attacks as well i get very emotional and teary i have recently had echo cardiogram, chest x ray and having stress eco tuesday the 6th october,i live on my own and find it hard to open up and discuss this, i am under a phycolagist which is helping ,i also have weakness in my legs and losing weight, i have never felt i was good enough .i also get very cold down my left side.